Provider Demographics
NPI:1336275411
Name:BECKER, STEFAN M (LMHC)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:M
Last Name:BECKER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 WASHINGTON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6874
Mailing Address - Country:US
Mailing Address - Phone:617-833-7241
Mailing Address - Fax:617-698-5844
Practice Address - Street 1:1614 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2201
Practice Address - Country:US
Practice Address - Phone:617-359-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1336275411OtherBLUECROSS BLUE SHIELD